Utility of non-high-density lipoprotein cholesterol in hemodialyzed patients

• Published in: Metabolism, clinical and experimental Vol. 53; no. 8; pp. 1013 - 1015
• Main Authors: Schreier, Laura, González, Ana I, Elbert, Alicia, Berg, Gabriela, Wikinski, Regina
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2004; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Apolipoproteins B - blood; Biological and medical sciences; Biomarkers; Cardiovascular Diseases - blood; Cardiovascular Diseases - etiology; Cholesterol - blood; Cholesterol, HDL - blood; Emergency and intensive care: renal failure. Dialysis management; Humans; Intensive care medicine; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Lipids - blood; Lipoproteins - blood; Medical sciences; Predictive Value of Tests; Prognosis; Renal Dialysis; Risk Assessment; ROC Curve; Treatment Outcome; Triglycerides - blood; Human; Kidney disease; Urinary system disease; Lipoprotein VLDL; Hemodialysis; Lipids; Terminal stage; Cardiovascular disease; Triglyceride; Density; Blood plasma; Nephropathy; Apoproteins; Cholesterol HDL; Limit; Lipoprotein HDL
• ISSN: 0026-0495; 1532-8600
• DOI: 10.1016/j.metabol.2004.01.001

Non-high-density lipoprotein-cholesterol (HDL-C) is proposed as a strong predictor of cardiovascular disease (CVD). Measuring non-HDL-C, as total cholesterol minus HDL-C, is convenient for routine practice because, among other advantages, fasting is not required. There are limited data of non-HDL-C in end-stage renal disease patients. We applied non-HDL-C calculation to 50 chronic renal patients receiving maintenance hemodialysis (HD) and 20 healthy subjects, apart from measurement of low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL) HDL, intermediate-density lipoprotein-cholesterol (IDL-C), apoprotein (apo) B, and triglycerides. HD patients presented higher plasma triglycerides and IDL-C and lower HDL-C than the control group, even after adjustment for age ( P < .05). VLDL-C increased in HD patients ( P < .001) while differences in non-HDL-C did not reach significance ( P = .08). To detect which parameter constitutes a better marker of CVD risk among HD patients, a receiver-operating characteristic (ROC) analysis was performed considering HD patients in the highest risk group for CVD. In the ROC graphic, the plots of VLDL and IDL-C exhibited the greater observed accuracy and the best performance, while non-HDL-C showed a curve close to the 45° line indicating that this parameter is a poor discriminator for evaluating CVD risk among HD patients. Non-HDL-C calculation, expressing all apo B-containing lipoproteins, may miss the significant contribution of each atherogenic lipoprotein, such as increase in IDL. This observation would not be in agreement with the currently proposed application of non-HDL-C a useful tool for risk assessment among HD patients.